The Fall and Rise Of Kilmer McCully

Published: August 10, 1997

(Page 5 of 5)

James believes that as long as the management of the Heart, Lung and Blood Institute espouses the cholesterol line, ''then the review committees, the other evaluating bodies, are going to be influenced -- not by written memoranda but by the environment and by word of mouth.''

But James sees an even bigger reason for cholesterol's dominance of the heart-disease debate: ''It's the money that's the problem. Look at the colorful advertisements in general-interest publications, explaining to grandfather that his grandchildren want him to stay alive using these drugs. The anti-cholesterol medications are multibillion-dollar industries now, and they have a huge stake in fanning the flames of the cholesterol mission.''

Charles Hennekens, a professor at Harvard Medical School and chief of preventive medicine at Brigham and Women's Hospital, cites the example of aspirin. ''For years now, we've known about these large benefits of aspirin in treating acute heart attacks and survivors of heart attacks, and yet we have underutilization of it,'' he says. ''At an F.D.A. advisory committee meeting recently, I joked that if aspirin were half as effective, 10 times as expensive and on prescription, maybe people would take it more seriously.''

Like aspirin, the vitamins that control homocysteine levels are readily available, inexpensive and nonexclusive. ''It's inescapable that there's just not the commercial interest for supporting research in homocysteine,'' Stampfer says, ''because nobody's going to make money on it.''

McCully takes this follow-the-money approach to its logical conclusion: who stands to gain? ''The most dramatic improvements in longevity over the last couple of hundred years have been through public health, not through medicine,'' he says. ''But public health is notoriously unprofitable. People don't make a profit preventing disease. They make a profit through medicine -- treating critical, advanced stages of disease.''

Although there's not much money to be made from doctors prescribing vitamins and offering dietary guidelines to heart-disease patients, corporate wheels are already turning to make homocysteine levels the latest, hottest measure of optimal health. A new TV commericial for Centrum multivitamins singles out folic acid because it ''may help reduce homocysteine levels in the blood, an emerging risk factor for heart disease.'' McCully says that Abbott Laboratories has developed a test for homocysteine, though he feels it is inadequate. ''Once we develop a better test,'' he says, ''I would like to think that the vast majority of heart patients, far greater than the current estimates of 10 to 15 percent, will show this striking elevation in homocysteine.''

Such confirmation may come years from now, and McCully realizes that he may not play a role in it. ''Generally speaking, a scientist makes one contribution and then everybody else takes over and it becomes extremely competitive,'' he says. It is only when pressed about the past that McCully reveals, briefly, the shadow of disappointment that must have loomed larger two decades ago. ''Last October,'' he says, ''the pathology department at Mass. General had a reunion and invited me, and I saw one of the people involved in my leaving the department. 'Well,' he said to me, 'it looks like you were right after all.' It's 20 years later. My career is almost over. There's really not much that can be done about 20 lost years, is there?''

Worse, the political and economic forces that undid McCully back then may be more intense today. Last April, The New England Journal of Medicine published an article titled ''The Messenger Under Attack -- Intimidation of Researchers by Special-Interest Groups,'' which detailed three cases of harassment by advocacy groups, physicians' associations or academic consultants who often failed to disclose their ties to drug companies. With more and more pressure groups weighing in on what research gets financed and promoted, the article said, ''such attacks may become more frequent and acrimonious.''

Photo: Kilmer and Annina McCully at their home in Winchester, Mass. (Photographs by Lizzie Himmel)